Modifier 51 & 59

tracylc10

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I have a question about the way one of my providers coded a surgery.

58570
57288-59
57240-59-51
56810-59-51

For starters, 57240 and 56810 are bundled, so I don't believe they should be coded separately. Now the 58570 is a Laparoscopic procedure and the rest are vaginal approach. My question is about the use of Modifier 59, is it correct to use 59 because of the different approaches? I was just a little confused by this, because my understanding of 59 was that it was used for procedures that are normally not done at the same time.

Just looking for some insight regarding this. If anyone can help I would greatly appreciate it.

Thank you.
 

CodingKing

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It almost seems to me this is a physician that puts 59 on everything to force claims past any clinical editing. If that's true that a very big compliance. I sure hope that's not the case but I thought I'd bring it up

Modifier 59 goes on the column 2 code if it meets the criteria for separate reimbursement

56810 is a column 2 code to 57288 & 57240. 59 would only belong on the 56810. However in the case both codes have an indicator of 0 so modifier 56810 is going to deny no matter what modifiers are used

Modifier is not needed on 57288 or 57240 as they are not column 2 codes to any codes on the bill
 
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tracylc10

Guru
Messages
193
Location
New Braunfels, TX
Best answers
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It almost seems to me this is a physician that puts 59 on everything to force claims past any clinical editing. If that's true that a very big compliance. I sure hope that's not the case but I thought I'd bring it up

Modifier 59 goes on the column 2 code if it meets the criteria for separate reimbursement

56810 is a column 2 code to 57288 & 57240. 59 would only belong on the 56810. However in the case both codes have an indicator of 0 so modifier 56810 is going to deny no matter what modifiers are used

Modifier is not needed on 57288 or 57240 as they are not column 2 codes to any codes on the bill
Thank you CodingKing. I have been doing a lot of research on modifier 59, because this doctor does use it a lot. My question is, if the procedure is done through a different incision, but the same anatomical site, can you use modifier 59? The doctor told me that this was their understanding of it. Says that since the hysterectomy was done laparoscopically and then the repairs were done through the vagina, that 59 is appropriate.

My feelings were that it should have been coded like this:
58570
57288-51
57240-51

Found this too: https://www.aapc.com/memberarea/forums/attachment.php?attachmentid=2404&d=1461794859

Thank you again. Sorry to be a bother.
 
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